Since 1993 there have been a number of new medications approved for the treatment of epilepsy. These new medications have provided new options that were not previously available to treat epilepsy. Many patients that have not had their seizures controlled with the older medications have found that the new medications have provided them seizure control.

Felbamate was approved by the FDA in early 1994 and was the first new drug for epilepsy to be approved in 15 years. Although there was great initial enthusiasm for this agent, in less than a year post-marketing surveillance revealed an unacceptably high rate of drug-related aplastic anemia.

Lamotrigine was approved in late 1994. It is thought to act by blockade of sodium channels; useful in partial seizures and possibly also in primary generalized seizures.

Gabapentin is approved for use as an “add-on” medication for treatment of partial seizures. Mechanism is uncertain; toxicity is low and does not induce or inhibit metabolism of other anticonvulsants.

Topiramate approved in 1997; unknown mechanism, possibly acts on voltage-gated Na+ channels.

Tiagabin - an inhibitor of GABA reuptake, approved in 1997 as “add-on” for treatment of partial seizures.

Levetiracetam – analog of piracetam, mechanism uncertain, approved as “add-on” for refractory partial seizures.

Vigabatrin - an inhibitor of GABA transaminase, the degradative enzyme for GABA; approved as an “add-on” agent in refractory epilepsy
Zonisamide, a sulfonamide derivative approved for partial seizures; acts on Na+ channels.

Pregabalin - this drug is approved for use in adults as adjunct therapy for partial onset seizures. Lyrica, which is also used to treat diabetic peripheral neuropathy and postherpetic neuralgia, can be taken 2 or 3 times a day.

All these medications belong to the second generation of AEDs. It is generally considered that these AEDs are better tolerated and safer than first-generation AEDs as they have less severe side effects.

Tags: aed, antiepileptic, gabapentin, neurontin.

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